As a therapist, you know that your patient deserves as much confidentiality as you can give them. While you may be a mandated reporter and have to report abuse or other serious threats, you know that the majority of your sessions will remain private.
For therapy to work, confidentiality is a must. If patients believe that you will spread around information about them, then they may not speak to you. Whether they’re children or adults, confidentiality is essential.
There are times when you may need to break confidentiality, though, and that could put you in a difficult position.
When does a therapist need to break confidentiality?
Normally, therapists are required to break confidentiality only in a few situations, such as if:
- The therapist suspects abuse to a child, adult or elder
- A qualifying court order has requested specific patient documents
- The client has directly asked the therapist to share their notes or information
- The patient is a direct threat to themselves or others
- The patient is being investigated as a subject in a national security investigation
Breaking confidentiality is usually not something that a therapist wants to do, because doing so could put them at risk of being accused of violating HIPAA and other confidentiality contracts. The work that the therapist has done with the patient may also be at risk of coming undone if the patient no longer trusts that individual.
Interestingly, the professional ethical codes in medicine don’t specifically determine when therapists have to break confidentiality. Instead, the law determines times when it’s appropriate to do so. Ethically speaking, most therapists will maintain confidentiality even when it’s not necessary to do so. If confidentiality does have to be breached, it may be breached only as much as required to handle an investigation or case appropriately.
If you do have to break confidentiality, make sure you discuss it with your colleagues or employer before doing so. You may want to look into the legal implications of doing so before you do, too. That way, you can take steps to protect yourself and your license, so you can continue to help everyone you can.
